In less than a decade, the United States has experienced two major disasters - the attack on the World Trade Center on September 11, 2001, and the 2005 hurricanes in the Gulf Coast. In both of these instances, public officials have struggled to provide an adequate emergency response and implement measures to protect the health and safety of affected communities and rescue workers and volunteers.1,2 Racial and ethnic minorities are at risk in face of disasters in terms of preparedness, impact, the aftermath, and rebuilding and clean-up efforts.3
Immigrants4 in disaster areas are especially vulnerable because of their immigration status, lack of English proficiency, and lack of access to resources.5 Consider, for example, the experience of immigrant Mexican teenagers who were working to remove excrement-fouled carpets without protective equipment as part of the New Orleans clean-up effort after Hurricane Katrina.6 In another example, Brazilian workers recruited to perform post-hurricane cleanup work were given inadequate protective equipment and had to eat their lunch in the midst of medical waste and dead laboratory animals while sitting on chairs that they had just removed from a hospital basement.7 According to the Environmental Protection Agency, such post-disaster cleanup activities can pose "significant environmental and health challenges" with potential exposure to life-threatening hazards which require implementation of safety procedures and use of protective equipment.8 The problems caused by working with harmful substances and in dangerous conditions are compounded by the lack of adequate health and medical services, especially for undocumented workers.5
The increasing diversity in the United States and the significant demographic changes throughout its regions in recent years call for a more targeted response in meeting the needs of immigrants in affected disaster areas. Immigrants represented 12.0 percent of the U.S. population in 2004.9 Of the 34.3 million immigrants in the United States, less than half (42 percent) are naturalized citizens. Furthermore, 52.4 percent of immigrants are from Latin America, 27 percent are from Asia, 14.3 percent from Europe, and 3.3 percent are from Africa. Of the total U.S. population over age five, 18.7 percent speak a language other than English at home, with 8.4 percent nationwide speaking English less than "very well."10
Traditionally, California, New York, Florida, Texas, New Jersey and Illinois have been the primary destination for new immigrants, accounting for 68 percent of all immigrants in the United States.11 In more recent years, other regions have been experiencing rapid growth in immigrant populations. Between 1990 and 2000, the number of immigrants increased by 88 percent in the South, 65 percent in the Midwest, 50 percent in the West, and 38 percent in the Northeast. When one looks at individual states outside of the "traditional destination" states, the numbers appear even more dramatic. Immigrant populations increased between 1990 and 2000 by 274 percent in North Carolina, 233 percent in Georgia, and 202 percent in Nevada.11 In the year 2000, the top five immigrant groups in the Gulf States were Vietnamese, Honduran, Mexican, Indian, and Cuban.12
Immigrants comprised 21.4 million (14.5 percent of the total) of the U.S. labor force in 2004. The number of immigrant labor force participants grew a net of about 1.2 million and accounted for a little less than half of the total labor force growth between 2002 and 2004.13 Immigrant families, even though they are just as likely to have a full-time worker in the family, are more likely to be poor than citizen families, due to the fact that immigrants often perform low-wage jobs, especially during their initial period of adjustment in the United States. Immigrants also are more likely to work for small businesses and in the agricultural, labor, and repair industries.14
Despite these challenges, immigrants play an important role in U.S. society and the economy. New immigrants tend to be young adults who join the labor force.15 They also tend to be healthier than U.S. citizens or immigrants who have been here for 10 years or longer - which means fewer public expenditures and more work.5, 16,17 Immigrant workers meet a demand for labor that is otherwise not met by citizen workers, and the U.S. economy depends on the continued presence of immigrants to sustain its current growth.18 Their purchasing power as new consumers of goods and services and the new businesses that they start create jobs and contribute to revitalization of depressed economic areas.15 In fact, inner cities with the greatest job growth count immigrants as nearly a third of their population, while inner cities with low percentages of immigrants are losing jobs.19
Excluding refugees (who come to the United States for humanitarian purposes under U.S. foreign policy), low-income immigrants also are much less likely to receive major public benefits such as cash assistance, food stamps, and health coverage, than low-income citizens.15, 20
America's changing demographics necessitate a targeted response to address the needs of immigrants, including low-income, non-English-proficient and/or undocumented immigrants, in disaster areas. Without such a targeted response, federal, state, local and private entities miss an opportunity to provide an effective, adequate and equitable emergency response to ensure the health and safety of all those who reside in the United States.
Needs of Immigrants and Refugees
Many of the short-term and long-term needs of immigrants and refugees affected by disasters are similar to those of other internally displaced persons. However, immigrants face particular problems and barriers relating to their immigration or refugee status, limited English proficiency, discrimination, and other factors that can impede access to disaster relief and other services that affect their health status and well being.5, 21, 22
These include:
A. Lack of involvement in preparedness planning. Racial and ethnic minorities, including immigrants, are less likely to have had disaster educational opportunities and to be involved in hazard preparedness, such as stockpiling emergency supplies and/or purchasing insurance.3, 23 Similarly, other persons with special needs, such as persons who are frail elderly and persons with mobility impairments, cognitive impairments or other disabilities also have to be involved in and/or taken into account in disaster preparedness.24
B. Lack of information on their rights and available assistance. Immigrants and refugees typically do not have access to accurate information about the services and benefits available to them and how their immigration or refugee status affects their eligibility for these services and benefits.25, 26
C. Language and cultural barriers to emergency response and assistance. Cultural ignorance, ethnic insensitivity, racial isolation and racial bias in information dissemination and relief assistance all contribute to the disparate impact to and recovery for low-income persons of color.3, 23 Persons with limited English proficiency (including immigrants and refugees) for example, often do not get the information they need about available disaster relief and their legal rights.26 In the past, government agencies and major private relief agencies typically have failed to provide materials or interpreters to serve monolingual survivors or to provide culturally appropriate services, and agencies with linguistic and cultural capacity often are small and very under-resourced.27
D. Barriers to disaster relief and government benefits. Immigrant eligibility rules complicate access to the benefits that many need to protect their health and get back on their feet. For example, lawfully residing immigrants cannot access Medicaid and other federal means-tested public benefits during their first five years in the country under the provisions of the Personal Responsibility and Work Opportunity Reconciliation Act,28 a policy whose flaws are particularly apparent when applied to disaster victims whose needs for assistance are immediate. Even after five years, benefits are extended only to those in a limited range of immigration categories. These categories do not include immigrants who have been lawfully residing long-term, such as those granted temporary protected status (TPS). Undocumented immigrants, although eligible for non-cash emergency disaster relief, are not eligible for cash benefits or assistance from many existing programs such as non-emergency Medicaid. Even when immigrants are eligible for assistance, many are afraid to apply due to fears that receipt of benefits will have "public charge" consequences, compromising future efforts to secure permanent legal status.29, 30, 31
E. Lack of legal status. Fearing immigration consequences, many immigrants are reluctant to seek assistance.23,27,30,32,33 In some cases, like in the Katrina hurricane disaster, some immigrants reportedly have been denied assistance by major relief organizations such as the American Red Cross and the Salvation Army.23,27 Also, the Department of Homeland Security (DHS) has not consistently assured affected immigrants that information they provided to the Federal Emergency Management Agency (FEMA) and other relief agencies in the course of seeking disaster assistance would not be used as a tool of immigration enforcement against them, an assurance that was extended after the September 11, 2001 terrorist attacks, but not after the Katrina hurricane disaster.33 It was reported, that when FEMA set up their offices to receive post-Katrina disaster relief, they often used Bureau of Immigration and Customs Enforcement officers as their "security."23
F. Loss of legal status. The ability of immigrants to remain in the United States lawfully may be compromised. For example, if an immigrant worker-s legal status is tied to a particular employer and that employer is wiped out by a disastrous event, the worker may face forced departure on top of other hardships.21 Similarly, an immigrant who derives legal status from a spouse or family member who dies in a disaster may have lost the legal right to remain in the United States.30
G. Loss of documents proving lawful immigration or refugee status and employment authorization. Non-citizens may lose identity documents necessary to prove lawful status so that they can obtain employment, travel, and other benefits that would allow them to survive in the communities where they have relocated without fear of immigration enforcement or harassment by local law enforcement or others. They need assistance to re-establish their identities and their legal status.21,30
H. Loss of refugee services and re-traumatization. Some of the victims displaced by the disaster were already refugees in the process of resettling in the United States. Refugees are admitted to the United States. via an organized time-limited program that seeks to ensure a smooth transition, both for the refugees and for the communities where they settle. This program has been destroyed in the Katrina-affected areas, but the special linguistic, cultural and mental health needs faced by refugees remain. Under current law, temporary medical and cash assistance are available to refugees only during the first eight months after they secure such status; other services may be available only during their first few years in the country. An extension of such services will be necessary to ensure a smooth transition and integration into a new community. Such assistance will also help the receiving communities that otherwise do not have the resources to cope with an influx of refugees with special needs.26,35
I. Danger to health and safety and unfair treatment of immigrant workers involved in reconstruction. As in the case of the 9/11 attacks and hurricane Katrina, immigrant workers often are heavily engaged in reconstruction efforts. Immigrant workers have encountered substandard, unsanitary or no housing, nonpayment of wages, and dangerous working conditions, including exposure to mold, particulate matter, asbestos fibers, lead, silica-containing dusts, toxic fumes, contaminated sediment, hazardous waste, contaminated flood water and other hazards without appropriate safety equipment and training, with threats of removal if they complain.5, 7, 35, 37-40 Federal action and law enforcement also can leave immigrant workers even more vulnerable to exploitation and dangerous work conditions. For example, immigration authorities impersonated OSHA officers in a widely publicized sting operation in North Carolina. Law enforcement officers and/or U.S. Marshals reportedly raided two Red Cross shelters in Mississippi, targeted Latinos, assumed that they were undocumented workers instead of hurricane survivors, and told them to leave.5, 23, 27 Also, on Sept. 8, 2005, the administration suspended the Davis-Bacon Act, which normally requires contractors on federally funded construction projects to pay workers the local prevailing wage, in areas affected by Katrina. Application of the law was reinstated on Nov. 8, 2005, in response to an outcry from labor unions and members of Congress from both parties who were concerned with profiteering at the expense of workers.27,41-44 However, immigrant workers, particularly those who are undocumented, continue to face wage exploitation and other abuses.5
J. Pre-existing racial, ethnic and economic disparities. Communities suffering from poverty, discrimination, unemployment, safe and adequate housing shortages, homelessness and other issues even before disaster strikes are susceptible to the worst impact of disasters and experience greater difficulty in recovery and reconstruction.3,45
K. Inadequate Safety-Net and Insufficient Appropriate Resources. The impact of disasters such as 9/11 or Katrina is also more harshly felt by low-income communities and persons of color, including immigrants, because of an under-resourced safety net that continues to be eroded. Programs upon which low-income individuals rely, including Medicaid, SSI, foster care, child support enforcement, and student loans, are being gravely undermined by tremendous domestic program budget cuts,46-48 tax breaks for the highest income individuals,49 and billions of dollars of war spending, contributing to a debilitating national deficit.50
It should be noted that APHA policies 200123, 9401, 9501, 9601, 9401 and 8223 all specifically support immigrant access to health services regardless of documentation status; that APHA Policy 9009: A Call to Reject English-Only Legislation urges states that have enacted English-only legislation to make provisions so that translation and culturally and linguistically relevant materials are provided; that APHA Policy 200120: Support for Culturally and Linguistically Appropriate Services in Health and Mental Health Care specifically urges states and local providers to comply with Executive Order 13166 which mandates a system by which individuals with limited English proficiency can meaningfully access services; that APHA policies LB-01-03, 2002-5, 2002-7, 2005-4 urge worker protection, including immigrant worker, health and safety while responding to disasters;51 and that APHA policies 2003-13, 9602, 8802 urge the federal government to maintain and expand Medicaid funding, policies 8128 and 6810 request the continuation of funding for food assistance programs that alleviate malnutrition and the problems associated with it, and policy 5702 requests the Public Health Service to increase its activities in the hygiene of housing.
Recommendations
Therefore, APHA calls upon Congress, federal and state agencies, local governments, and private relief agencies to implement the following policies and actions to protect the health and well-being of immigrants and the public health of all persons in affected disaster areas and in the states in which immigrants and other survivors have relocated:
References
